developmental disorders | Centar iLab | Page 2Centar iLab

A cranky baby? – behind the scene

“My baby cries a lot.”
“My baby doesn’t want to eat (solids).”
“My baby doesn’t like to get dressed.”
“It’s impossible to put my baby to sleep.”
“My baby doesn’t like to ride in a car.”
“My baby doesn’t like to spend time on her tummy.”

All of these are frequent examples of children’s reactions to sensory stimuli from the environment. To explain it a little bit: there may be many reasons for a baby to cry constantly or not to be able to sleep and it is up to us to find a pattern in the activities that preceded the negative reactions: e.g. bathing, dressing, feeding, going out in the sun etc. It can also be a reaction to an absence of a stimulus. For example: a baby or a child will not be able to fall asleep until he or she gets enough of proprioceptive stimuli (e.g. when we tightly hold the baby in hands). Children who have some oral motor and sensory difficulties will most likely have difficulties breastfeeding (sucking) or will have difficulties chewing their food, especially the solid, chewy items. Also, they might be irritated by the smell or the texture of the food. Furthermore, if a baby is hypersensitive to touch, she might cry while you try changing her clothes and might even be bothered by the etiquette or different materials in her clothes. Children who are hypersensitive to the vestibular stimuli most likely will not enjoy the car rides, while the children on the opposite side of the spectrum love the rides, swinging, walking on a beam (or couch armrest) and other unstable surfaces. Concerning the tummy time, if a child has a vestibular problem, they will probably not want to have their heads in a position towards the floor. If they have low muscle tone, they might have an issue holding their heads up or they might have a problem with their shoulder girdle.

Let me make this more clean with an example of a boy I worked with. He was 9 months old when he came to me and the reason his mom brought him was that he did not sit by himself. So, in our first meeting, I put the boy down on a mat and waited to see his spontaneous movements, reactions and motor skills. He did not want to turn to his tummy. I tried using the toys to get him to turn and stay like that, but he would immediately start to cry very intensely. Putting him into a side sitting position also scared him a bit and he would continue to cry. He didn’t even want to have his fists on the ground in front of himself. But, while he was on his back, he would hold a toy in his hands. After getting to know his motor skills, I took a look at his sensory profile since children until the age of 7 are very sensory oriented. I noticed this boy was hypersensitive to tactile stimuli on his fists and that was the reason he was not using the side sitting. The boy did not want to put his hands onto the floor which prevented him from getting and being in this position. Also, he did not want to have his head face the floor. While on the tummy or on all fours where head needs to be in that position tell us there might have been some vestibular difficulty. The vestibular system gives us information about the head position. When I realized what his sensory difficulties were, I started working with him on a swing – we would swing forward-backward as the linear swinging regulated him.This way we worked and played without any tears.

It is important to know what preceded some negative reaction your child had and look at the situation through sensory glasses. For example, if your child doesn’t like to get dressed and you only manage to put some clothes onto your baby while somebody is holding her or singing, take it as a clue that your baby needs more proprioceptive or auditory stimuli to get regulated. You can give your baby some deep pressures all around his body, especially the joints as if you were trying to reach their bones. Do not squeeze your baby or pinch or lightly caress, just give deep and relaxing pressure with your whole palm. Then, try to get your baby dressed. Any difference in his or her behavior now? If not, check if your baby has a preference in materials and textures or is she or he bothered by the etiquette on the clothes or if the clothes are too cold (after giving a warm bath, clothes can sometimes appear cold).

Posted on June 2, 2014 by lina. 6 comments

Što se potencijalno krije iza bebinog negodovanja?

“Moja beba jako puno plače“.
“Moja beba ne želi jesti (krutu hranu)”.
“Moja beba se ne voli oblačiti“.
“Moju bebu je nemoguće uspavati“.
“Moja beba se ne voli voziti u autu”.
“Moja beba ne voli biti na trbuhu“.

Sve su to česti primjeri reakcija na osjetilne podražaje iz okoline. Da ukratko obrazložim; može biti mnogo razloga za bebin konstantni plač ili nemogućnost spavanja te bi trebalo pronaći uzorak u tome što prethodi tim radnjama: oblačenje, kupanje, hranjenje, izlazak na sunce itd. Može biti i odsutnost nekog podražaja. Na primjer: beba, odnosno dijete, neće moći zaspati dok ne dobije dovoljno proprioceptivnog podražaja (npr. čvrstog dodira na površinu cijelog tijela kao kada bebu nosimo u naručju). Djeca koja imaju problem oralne motorike i senzorike, teško će sisati majčino mlijeko ili bočicu ili žvakati krutu, pogotovo žilaviju hranu. Također, možda ih smeta intezivan miris hrane ili njena tekstura. Zatim, ako je beba taktilno preosjetljiva, plakat će za vrijeme skidanja i oblačenja te će ju možda smetati i etikete ili neki drugačiji materijali. Djeca koja su vestibularno preosjetljiva neće uživati ili se brzo i lako opustiti za vrijeme vožnje u autu, dok će djeca hiposenzitivna na vestibularni podražaj uživati u vožnjama, ljuljanju, hodanju po gredi (rukovatu od kauča), nestabilnim podlogama itd. Što se tiče boravka na trbuhu, ako je problem vestibularni, onda neka djeca neće htjeti imati glavu u položaju prema podu. Ako je problem niskog mišićnog tonusa, možda im je teško držati glavu gore ili ima možda problem ramenog obruča.

Primjer: Radila sam s jednim dječakom od 9 mjeseci koji je došao na pokazne vježbice jer još nije samostalno sjedio. Na prvom sastanku s njim, kada sam ga stavila na strunjaču i pričekala da vidim spontane kretnje, reakcije i motoriku, nikako se nije okretao na trbuh. Koristeći igračke pokušala sam ga motivirati na boravak na trbuhu, ali nije se htio niti okrenuti, a kamoli boraviti dulje. Odmah bi počeo intezivno plakati. Postavljanje u bočni sjed ga je također dosta plašio te bi i dalje dječak jako plakao. Ručice nije htio držati ispred sebe u bočnom sjedu, ali dok je bio na leđima, ipak bi držao igračku u rukama. Nakon upoznavanja njegove motorike, pogledala sam ga i kroz senzoričke naočale jer su djeca do sedme godine života izrazito senzorička bića. Ispitujući dječakovu senzoriku vidjela sam da dječak ima hipersenzitivno taktilno odstupanje na šakicama te je to razlog njegove nemogućnosti da samostalno zauzme bočni sjed. Jednostavno nije htio držati ručice na podlozi, što je neophodno za ovaj položaj. No, problem je bio i u položaju glave. Dok je na trbuhu i u četveronožnom položaju gdje glava treba gledati prema dolje, možda postoji i vestibularno odstupanje. Vestibularni sustav nam daje informaciju o položaju glave. Kada sam otkrila koja su njegova senzorna odstupanja, krenula sam izvoditi vježbice i položaje na ljuljački koju sam ljuljala naprijed – natrag (linerano ljuljanje) koje je dječaka organiziralo i reguliralo te smo na taj način bez suza postizali sve položaje.

Važno je otkriti što je prethodilo nekakvoj negativnoj reakciji Vašeg djeteta i pogledati situaciju kroz senzorna načela. Na primjer, ako se Vaše dijete ne voli oblačiti i jedino kada Vam to uspijeva je dok bebicu netko drži ili pjeva, uzmite to kao znak da bebici možda treba više proprioceptivnog ili auditivnog podražaja za regulaciju. Možete bebici priuštiti duboke pritiske po tijelu, pogotovo po zglobovima, kao da želite prodrijeti ispod kože do kosti. Nemojte bebu štipati ili lagano dodirivati, samo dajte smirene i duboke pritiske cijelim dlanom. Nakon toga pokušajte s oblačenjem. Ako to nije pomoglo, pogledajte što je još prethodilo plakanju. Ima li razlike u ponašanju s obzirom na različite materijale odjeće? Smeta li Vašu bebu etiketa na robici, temperatura odjeće (npr. iz tople kupke u hladan bodi).

Posted on June 2, 2014 by lina. 5 comments

Pump up child’s proprioceptive system

These are some of the things you can do with your child to bring his/her proprioceptive system closer to the regulated state:

utilize your home:
- lay mats of different thickness and softness onto the floor (information coming from the joints)
- put some mats or safety sponges onto the walls (for children who like to run and bounce themselves off of the walls)
- have Pilates kind of balls in the space (child can roll on the ball on their stomachs or you can lightly massage them with the ball on their backs or squeeze them in between two balls, or have them jump on the Pilates ball while catching some other small objects)
- big cushions (take a duvet cover and fill it up with pillows, Styrofoam or small soft balls and have your child jump on it, cross over it, crawl on it, lay down on it etc.)
- fill up the crib with small plastic balls to make a ball pit.
have fun out in the streets:
- pass each other a ball, small stone, pine cone
- pick up pine cones or stones into buckets of different sizes (thus different weight)
- try walking and running with small weights around the ankles
- walk around in a vest with some weight in it
- walk in deep snow, through puddles of water, sand, in high grass, in mud, different surfaces
- walk up or down the steep streets
other creative activities:
- make a dough out of water and flour. Some can be smooth and soft, some you can make rough by adding seeds and some you can make a little dry. Ask your child or show them how to pull a little bit of dough with their fingers, make a small ball and paste the ball onto a piece of paper. For older children, you can make a line or a shape on that piece of paper and they should paste the dough balls onto the lines. This is also great for tactile regulation
- jump on the trampoline in a rhythm

Posted on May 31, 2014 by lina. 0 comments

Sensory or Behavior?

This is one of the popular and everlasting discussions among the professionals in sensory integration / child development field. When a child is having e.g. a tantrum, how do you know if it’s sensory or behavior? This is a very important question because it defines our reactions towards the child in that moment. And our reactions are there to help the child either by calming him down or by teaching him some boundary.

There is a consensus about a couple of things:

every child needs good* boundaries
every child needs good* structure

*not necessarily strict or harsh
While reading other people’s opinions on sensory or behavior question, one interesting answer pops up: it is sensory and behavior, and not sensory or behavior. It is very hard to define a behavior and not take the sensory factor into the consideration. If your child doesn’t want to eat something and is crying and jumping in their feeding chair, take a look at the food you gave them: is it too hot or too cold or perhaps too chewy? Children who have low muscle tone in the oral area will most likely find difficult to chew and will thus most likely refuse to eat e.g. some meats or bread crust. Those same kids, on the other hand, will want to get the stimuli the easy way and you might see them asking you for crunchy foods that are easy to chew through e.g. chips, salty sticks, rice cereals etc. Food temperature is also very important to sensory kids. Just try to make them get used to it step by step. Forcing them to eat something, whether of the “wrong” temperature or texture is only going to make them refuse it, even if they would initially want to taste it.

So, how come a lot of the times we get the report from the preschool teacher that the child ate everything and is eating nicely in the preschool and makes such a drama at home? Well, the answer may as well be – the structure. Don’t confuse this with boundaries. Parents may be very clear on the boundaries, but the structure is what is missing at home. Usually preschools organize time and setup for meals where all children eat together at a table at the same time. So, this structure and predictability helps a lot of the sensory kids in their organization and regulation. If they do not have to think about what’s coming next and how they will manage themselves in the new situation, but they know that at this time, kids will start getting together at the table and food will be served, those sensory kids can be at peace and they can participate in an adequate way. To go back to the structure vs boundaries – sometimes what happens is that parents put stricter boundaries or let’s say, stricter parenting to compensate for lack of structure. Perhaps this is a good question to analyze in one of the future posts.

Another question to be asked here is how to know whether your child’s current behavior is purely sensory or behavioral, though I said that usually it’s both? Well, The Anonymous OT gives a good point in his “Is it Sensory, Behavior or Both?” blog post.

This is where I tell my parents to be incredibly attentive to the subtle signs from their child. With any behavior analysis, there is an “antecedent,” or something that happens before the behavior. This is where the parent has to look for the clues. What was the root cause of the outburst?

I agree with this statement and have been recommending the parents I work with to do so – to try and figure out what happened right before some good or bad behavior. Important thing to know and remember is that kids are not bad, they do not want to act badly. Children actually want to please their parents. If a child is behaving “badly”, it is up to us to figure out why and help them.

P.S. I like this document!

Posted on May 30, 2014 by lina. 4 comments

Kako senzorički opremiti kuću?

English version

Jeste li vi među onima koji imaju prazan podrum koji k tome nije vlažan te je savršen za senzoričku sobu? Ja nisam! Mi živimo u stanu. Imam doduše garažu, ali ne odgovara ovim kriterijima. Prljava je, vlažna i puna stvari. Također je i dva kata niže. Svakako nije namjenjena za senzoriku. Moji roditelji imaju podrum, ali je također vlažan, prepun stvari i ima veliku škrinju. Ne odgovara našim potrebama. Dobra vijest je da vam ne treba zasebna prostorija. Jedna super strana senzorne integracije je što nas traži da budemo vrlo kreativni. Djeca i roditelji s kojima radim inspirirali su mnoge moje ideje, igre i trikove.

Dakle, što možete učiniti da vaš mali, skučeni dom bude senzorički povoljan? Počnimo razmišljati u 3D! Iskoristite svoje zidove, plafon, podove, vrata itd. Sve može biti korisno. Ali najprije pogledajte koje su potrebe i mogućnosti Vašeg djeteta. Jesu li potrebe Vašeg djeteta više proprioceptivne, vestibularne ili možda vizualne? Imajte na umu sva osjetila, ali u prostoru imajte malo više stvari koje podražuju ono osjetilo koje Vaše dijete najviše treba. Ne morate imati svu tu opremu i pomagala cijelo vrijeme nasred boravka i po cijeli dan. Mijenjajte raspored i opremu prema želji odnosno potrebi djeteta. I svakako imajte djetetovu sigurnost na prvom mjestu.

Za propriocepciju:

stavite strunjače različite debljine i mekoće na pod (informacije dolaze iz zglobova)
stavite i strunjače ili zaštitnu spužvu na zidove (poglavito za djecu koja se vole “zabijati” u zidove)
imajte pilates lopte (dijete se može ljuljati na lopti na trbuhu ili ga možete masirati loptom po leđima; malo ih stisnuti među dvije lopte kao u sendviču; mogu skakati na lopti dok hvataju neki drugi manji predmet)
veliki jastuci (uzmite plahtu od prekrivača i napunite ju jastucima, stiroporom za igračke ili malim lopticama da djeca mogu skakati po tome, puzati preko tog velikog jastuka, prelaziti preko njega ili pak leći na njega)
napunite krevetić ili vrtić malenim platičnim lopticama da stvori bazen s lopticama.

baby in the crib — http://community.babycenter.com/post/a41331646/ball_pit_time_pic

Za taktilno:

napravite taktilne ploče kod kuće (mogu biti jednostavne poput ovih kvadratića na slici niže dolje ili možete otići korak dalje i napraviti brojeve i slova od različitih materijala i tekstura, pa čak i PECS kartice u 3D!) i stavite to na zid. Ako imate veći neiskorišteni zid, možete ga obući u neku tkaninu ili materijal.

http://www.pinterest.com/genrescue/pecs-non-verbal-communication/

0021154 — http://www.specialneedstoys.com/can/discrimination/504-tactile-board.html

stavite različite materijale na pod i najbolje bi bilo da dijete boso hoda po njima, ako je moguće. Možete imati jedan kut sobe, ili kut od kauča popunjen jastucima različitih materijala i tekstura (mekani, tvrdi, izrezbareni, vuneni, krzneni, glatki, bodljikavi) te nekoliko jastuka koji izgledaju isto, ali su različite težine, te i treću kategoriju jastuka koji izgledaju isto ali su različito punjeni – grahom, sterilnim mačjim pijeskom, perjem, kamenčićima ili stiroporom)
bojanje i pisanje također može biti zabavno (zeleni kaktus je kemijska olovka te ako ste toliko kreativni kao ovaj dječak sa slike, možete popiti i malo mineralne vode (“pikave vode”) iz kaktusove posude).

Kupanje: voli li Vaše dijete vodu? Ako da, kupa li se u kadi ili ga tuširate? Voli li jaki mlaz ili slabi? Možete se igrati pjenom za brijanje dok se dijete kupa te staviti po licu i tijelu, namazati i patkice. Također dodajte i taktilne podražaje popust krupne soli ili šećera u pjenu i namažite na djetetove ruke ili tijelo. Bolje da se sami namažu. Možete dodati i jestivu boju za vizualni podražaj. Time možete namazati i igračkice za vodu koje su bodljikave, spužvaste ili glatke).
Oralno: dijete su može prati zube i trljati jezik i desni četkicom – postoje klasične četkice, no i one za bebe i od NUKa. Možete i svojim prstom masirati oko usta i obraze. Također i desni i jezik ako vam dijete dopusti. Moj sin obožava tu masažicu uz pjesmicu “Wheels on the bus”. Puno se smiješi na to.

Za vestibularno:

stavite ljuljačku u kuću (neki roditelji su instalirali mrežu za ljuljanje iznad svog bračnog kreveta pa bi se djeca popela i skakala na krevet – pazite na sigurnost!! Možete instalirati ljuljačku na plafon, a na susjedni zid stavite konop pa kada se ljuljačka ne koristi, samo ju zaglavite između zida i konopa da ju ne morate uvijek skidati. IKEA ima jednu ili dvije koje ja svakodnevno koristim. Dijete se može ljuljati u različitim pozicijama (dok sjedi, na trbuhu, na koljenima ili dok stoji) i u različitim smjerovima te možete kombinirati i druge aktivnosti skupa s ljuljanjem poput hvatanja lopti različitih težina (proprioceptivno) ili materijala (taktilno).
možete imati balansne ploče ili jastuke. One samo da daju vestibularni podražaj nego su bodljikavi pa daju i taktilni podražaj.
jedna majka s kojom sam radila je okrenula kauč naopačke i koristila ga kao tobogan za svoju kćer. Ja sam koristila velike jastuke za naslon te sam ih stavila niz kauč pa su se nećaci na tome spuštali kao niz tobogan.

Za vizualni:

zapravo svi materijali i oprema već imaju nekakvu boju i oblik. Ako je Vaše dijete osjetljivo na vizualni podražaj, pojednostavite Vašu opremu. Također smanjite i broj svjetala u prostoru. Za one koji su na drugom dijelu kontinuuma, možete uvesti više boja, oblika i veličina.
uzmite rotirajući reflektor s više boja

ako stavite strunjače različitih visina (boja i tekstura) na pod kao što sam napomenula u dijelu o propriocepciji, to je izvrsno i za vizualni sustav.

Kroz cijelu kuću: ponekad je teško zadovoljiti dijete kada je vani -30 stupnjeva C. Parkovi nisu najbolja opcija ne samo radi hladnoće i jer su mokri od snijega ili kiše nego i jer se u Hrvatskoj vrlo brzo zamrači po zimi, već oko 16 sati. Iz nekog razloga, kod nas u večini parkova nema ulične rasvjete. Ali ima nešto što možete učiniti i unutra. Iskoristite cijelu kuću ili barem dio za poligon: rasprostrite jastuke, strunjače, stolove, balansne ploče, lopte i sve što Vam se čini zgodno u niz prepreka. Ako Vaše dijete može pratiti upute, dajte mu i nekakvu igračku koju na cilju mora staviti u košaru. Cilj može biti i toliko jednostavan kao i poljubac mami. Preko nekih prepreka dijete može puzati, hodati, provlačiti se ili čak preskočiti. Evo kako je kod nas:

Možete uključiti i kućne ljubimce ako su raspoloženi!

Mogu proći i kroz otvor za pećnicu od dječje kuhinjice.

Ima li Vaše dijete brata ili sestru? – udružite ih! Neka jedan drugome budu prepreka ili most kroz koji se treba provući.

Neka dobiju dopuštenje za iduću prepreku nakon obavljenog kognitivnog zadatka.

i na kraju, na cilju, neka ubace igračku u košaru ili kao ovdje na slici, u vrećicu.

Budite kreativni i zabavite se!

Posted on May 29, 2014 by lina. 0 comments